We met with the oncologist today and said he had discussed the case with his tumor board and with the past trial oncologist.
He laid out several possibilities:
Keep going with Kadcyla and see what happens with the growing (and other tumors).
Irradiate the growing liver lesion and then continue with Kadcyla
Switch over to Carbo/Alimta + either Avastin or Keytruda. He suggests Keytruda would be the best since he suspects that while minor and asymptomatic my wife may still have the small brain lesions. If so, Avastin has significant brain bleed risks.
He thinks that the irradiation will only provide temporary, if any, relief since he suspects there may be more than this single lesion that is growing.
So, he thinks the best course at the moment is to switch back for 3 rounds of Carbo/Alimta (which he knows worked previously) with the added Keytruda (which has been shown in some cases to have additional effect). If it works, my wife would then go on Keytruda or ALimta/Keytruda maintenance. Of course both the Alimta alone and the (somewhat related to Keytruda) Opdivo alone were completely non-effective previously.
So, we are back to getting what was my wife's first chemo treatment with a twist, hoping the Keytruda will add a little something.
The oncologist also mentioned the possibility of Poziotinib down the line (about like the TAK my wife took previously, but hopefully with less side effects).
My wife is having an MRI this week (to confirm or deny the brain lesions) and a CT scan to see the current status of the lesions after the latest treatment and see if anything else is growing.
Once more.....back into the breech. I guess if there is one good point, it will get my wife off of any microtubule poisons for a few months, so hopefully the neuropathy will improve a little.